Role of Computed Tomography-guided Biopsies in the Era of Electromagnetic Navigational Bronchoscopy: A Retrospective Study of Factors Predicting Diagnostic Yield in Electromagnetic Navigational Bronchoscopy and Computed Tomography Biopsies

摘要

Objectives: Over 25% of the high-risk population screened for lung cancer have an abnormal computed tomography(CT) scan. Conventionally, these lesions have been biopsied with CT guidance with a high diagnostic yield.Electromagnetic navigational bronchoscopy (ENB) with transbronchial biopsy has emerged as a technology thatimproves the diagnostic sensitivity of conventional bronchoscopic biopsy. It has been used to biopsy lung lesions,due to the low risk of pneumothorax. It is, however, a new technology that is expensive and its role in the diagnosisof the solitary pulmonary nodule (SPN) is yet to be determined. The purpose of this study was to evaluate thediagnostic yield of CT-guided biopsy (CTB) following non-diagnostic ENB biopsy and identify characteristics ofthe lesion that predicts a low diagnostic yield with ENB, to ensure appropriate use of ENB in the evaluation of SPN.Materials and Methods: One hundred and thirty-five lung lesions were biopsied with ENB from January 2017to August 2019. Biopsies were considered diagnostic if pathology confirmed malignancy or inflammation in theappropriate clinical and imaging setting. We evaluated lesions for several characteristics including size, lobe,and central/peripheral distribution. The diagnostic yield of CTB in patients who failed ENB biopsies was alsoevaluated. Logistic regression was used to identify factors likely to predict a non-diagnostic ENB biopsy.Result: Overall, ENB biopsies were performed in 135 patients with solitary lung lesions. ENB biopsies werediagnostic in 52% (70/135) of the patients. In 23 patients with solitary lung lesions, CTBs were performedfollowing a non-diagnostic ENB biopsy. The CTBs were diagnostic in 87% of the patients (20/23). ENB biopsiesof lesions 21.5 mm were non-diagnostic in 71% of cases (42/59); 14 of these patients with non-diagnostic ENBbiopsies had CTBs, and 86% of them were diagnostic (12/14). ENB biopsies of lesions in the lower lobes were nondiagnosticin 59% of cases (35/59); 12 of these patients with non-diagnostic ENB biopsies had CTBs, and 83%were diagnostic (10/12). ENB biopsies of lesions in the outer 2/3 were non-diagnostic in 57% of cases (50/87); 21of these patients with non-diagnostic ENB biopsies had CTBs, and 86% were diagnostic (18/21).Conclusion: CTBs have a high diagnostic yield even following non-diagnostic ENB biopsies. Lesions 21.5 mm, inthe outer 2/3 of the lung, and in the lower lung have the lowest likelihood of a diagnostic yield with ENB biopsies.Although CTBs have a slightly higher pneumothorax rate, these lesions would be more successfully diagnosed withCTB as opposed to ENB biopsy, in the process expediting the diagnosis and saving valuable medical resources.